Getting Healthcare Right

It is hard to believe that so many people have such poor understanding of the healthcare issues, and that the approaches we see to improving them are so grossly misdirected. Let's try a new perspective:

First thing to look at is The cost of healthcare, including drugs- because that in turn controls the cost of insurance, and the cost of insurance controls people's ability to afford it. This is the core problem. The USA has the most expensive healthcare in the world, but not the best. Our costs are not just high- they are ludicrous, outrageous and virtually detached from the legitimate costs of services rendered. Examples:

* An emergency room visit for severe spasm of neck and shoulder muscles, with no apparent injury results in a CT neck scan, a shot of painkiller and a prescription for muscle relaxants. Time for services to be rendered- less than 45 minutes. Bill: $5,000.00. I know- it was me.

* Cost for normal childbirth, a medical service that has changed little over time, has gone from being equal to about 4 weeks income for an average person in 1970 to being about 24 weeks income today. Since income increases and reflects adjustments for inflation, this variable is all due to the increasing cost of this service at a rate 6 times faster than the economy it takes place in.

* In an American hospital- Tylenol is often billed at $15 per pill. (street price about $0.06)
A pair of non-sterile disposable gloves used by attending nurses- $53.00. (Street price $0.20)
Plastic cup used to administer medicines (just the cup) $10. (street price $0.06)
Use of alcohol swab- $23 each (street price $0.40)
Hospitals are padding the billings for these things to offset the cost of things they can't bill.

* A major surgery in the US such as hip or knee replacement will be about 5 times higher than the same surgery in many other nations with the same high-tech services. That means that for many, their deductible or co-pay for such surgery in America will cost them more than the complete charge for the same surgery done in Spain or other countries. This is now a thriving international industry- selling major medical services to Americans who can't afford it in their own country.

So why are these bills so huge?

Obviously it's not the cost of the Tylenol, which may well be provided free by the manufacturer for the advertising value of it being a hospital choice. The big problem is Overhead. While that is a broad class of expenses, it has a couple of items that are culprits to hold accountable, and your medical bill has this gross price padding in it because of those two things . One is excess regulations causing a great deal of paperwork and records expense. Two is the huge cost of malpractice insurance. (For example, insurance cost for an ObGyn may approach $200,000 per year). Malpractice litigation have become a predatory financial industry, with what used to be called ambulance chasing lawyers now taking to the television to convince people that if any aspect of their treatment wasn't perfect, they should sue. If you took a drug or had a procedure and experienced almost anything, you should sue. The legal motive here isn't justice- it's the third or half share in the financial settlement that goes to the attorney. This onslaught of litigation has forced the medical industry to practice defensive medicine- meaning that tests and procedures that a physician knows are not needed are performed anyway to protect against a predatory lawyer calling him negligent for not doing them, as well as keeping unnecessarily detailed records for the purpose of possible defense.All billed to you. When some attorney claims he has brought about justice- he profits more than his client, and all of us pay for it.

Bottom line is that we have two massive culprits behind the massive medical costs- Excessive regulations and excessively permissive litigation. In the discussions on health insurance, how many times have you heard our politicians address these two things? Never? So, why not?

One, regulations are the substance and essence of government power- and they never volunteer to restrain themselves in that area or take responsibility for the load they impose.

Two. the nature of politics is law, and most politicians are lawyers. Litigation provides the illusion that justice is serving the people- and that would be true if the litigation had true foundations in cause and was administered in a just environment. If you have any experience with tort law, you would know that your chances in court have little to do with justice, and everything to do with distortion of truth to gain profit for somebody. The popularity of this lawsuit industry is greatly enhanced by the fact that a baseless claim can be made and the sued party must defend itself, sometimes at a cost of millions of dollars- and that opens the door to a negotiated settlement where the plaintiff is paid simply to go away to avoid the expense of full defense. In many countries, the loser of such a lawsuit must pay the legal fees of the winner, and that discourages frivolous litigation- which lowers the cost of insurance dramatically. Not in the US. Here, the threat of a lawsuit can be a legal form of extortion, and our congress does not see fit to prevent that. The cost is part of your insurance premium.

IF we had these two issues- excess regulations and records, and inappropriate litigation under control, two things would happen. The cost of medical care would drop and the cost of insurance to provide medical care as well as the cost of malpractice insurance would drop, precipitously.

Now we would have a completely new game in healthcare insurance. We would see a huge increase in insured people- because they could afford it. At the same time, we could probably construct the mechanics needed to extend health insurance coverage to many who have chronic issues without raping everyone else.

It is utterly ludicrous to attempt to create some kind of effective health care policy when you are building it with a grossly bloated system in the first place. The results of that are unfair to everybody; there are no real winners- neither individuals or the nation as a whole. Congress needs to start with the real problems behind unaffordable health care to make it affordable, and thereby make insurance affordable- not just try to impose the ugly monster it is now on everyone, to harm us all equally.

 

The reason we have the highest-priced healthcare is because we have healthcare for profit.

PROFIT is why you pay $15.00 for a tylenol.

 

Nationwide stats for general hospital pre-tax profit margin: 7% of revenue. That would mean that a tylenol at that margin of profit would be costing $13.95- or that the hospital was making 96% profit, not 7%. The average profit for a small manufacturing business is 14%. Offices of physicans average 12.8% Data from Forbes business magazine

If you can't get realistic with the numbers, you can't understand the problem and have no way to construct a solution- and that is why we don't have a solution.
The costs of liability insurance for hospitals exceeds the total profit of hospitals.

 

The GOP plan is DOA.

They have realized it, and cancelled tonight's vote.

 

I agree. Unfortunately, there needs to be government control. You probably don't think I have a right to an opinion, but I'm from Canada. I can't imagine how you stay alive down there. I was once in the hospital for six and a half weeks with an infection after surgery and ended up having another surgery before getting out. I was in a private room because I was so sick. I left the hospital and paid two dollars to get out of the parking lot, and that's what it costed me

 

These links illustrate the cost of medical care when government/insurance compliance costs aren't included.

A couple of years ago I had a cardiac ablation performed, which might be roughly comparable to some of the procedures listed on this link. The bill for that ablation was about 280,000 dollars. I have pretty good insurance through my employer so my out of pocket was a little less than the total for some of the procedures listed in the link.

https://surgerycenterok.com/?procedure_category=cardiovascular#jump

My insurance requires a 25 dollar co-pay per office visit and a 500 dollar deductible per year. For that coverage for my wife and I the monthly (including the employer contribution) is 880 dollers per month. My subscription cost for this clinic in Wichita, Kansas would be 200 dollars a month for my wife and I. That would include all the tests the clinic does in house (MRI, X-Rays, blood tests, etc.).

http://atlas.md/wichita/our-fees/

This last link is a list of direct service for cash providers that might be useful for anyone looking for care without the bureaucratic compliance overhead.

https://aaps.wufoo.com/reports/m5p6z0/

 

Paperwork/regulations.

My sister in law opened as a provider with no employees. She found that EVERY insurance bill submitted was rejected on first application. From there, she rapidly became a full time paper pusher in order to get payment for services rendered. In the end, she went cash-only - her patients were free to try to submit their bills to their insurance, but my sister in law would have had to hire employees to do nothing but PAPERWORK and it had NOTHING to do with "regulations".

Hospital bills.

Let's remember that health care costs are one of the largest reasons for bankruptcy and that hospitals get a lot of indigents.

When you pay for a medication, you're also paying for those who get hauled in by the paramedics and brought back to life only to have the patient go bankrupt or otherwise be unable to pay.

And, yes, hospitals have collections departments, so they hire whole teams to go after the money the hospital is owed, finding people, working out long term payment plans, etc., etc.

 

We haven't paid to go to a doctor, even a specialist, since 1969

 

$280,000?????? I had one as well. Cost me nothing. That's because while our Medicare system would have required me to pay $350 for the actual procedure, I have private hospital insurance so the hospital fees were paid for and the gap between the fee for the ablation procedure ($1,372.45) was also covered.

 

The problem is that somebody did pay your bill, it still wasn't free. I'm not against there being some controlling policies at all- but they need to be good ones. The huge difference between running a business and a government is responsibility- it's far too easy to waste other peoples money, and it takes a person who is both skilled and honorable to handle it wisely. That is our downfall here- on both counts. I have family in Chatham, so I am somewhat familiar with the Canadian healthcare quality- but also aware of the huge tax level there.

 

We are all indigents in Canada,you might as well say. Having your health care card is the right of every individual from birth. You show your card, and no matter what happens; like if you get out 45 minutes later with a cast; or if you have a heart attack like one of the times my dad did, and come in from emerg, was flown 400 miles away to another hospital, stayed there for five days, have two procedures, all kinds of tests, surgery, and then was transported by ambulance 400 miles back, and a few more days in hospital back home. He paid two dollars to exit the parking lot and that's what it cost him. That is without seperate, paid for, insurance most of us pay for drugs and dental, vision,etc. I pay 89.00 a month for that.

 

Stories like yours never get told by the GOP. They keep picking examples where there are long waits for treatment - as if there aren't some long waits in the US - just try and get an organ transplant in the US - if you're not rich.

 

We have food for profit too, and automobiles and electronics and housing and clothing(even Goodwill is sustained by profit), and entertainment, and...

Maybe we eliminate the profit motive from those things like they did in Communist Russia. Then again, maybe profit motive really isn't the problem but is actually just part of human nature that we would do well to learn to live with.

 

or $1 for acetaminophen like a sensible person.

 

I, for one, would rather see more taxes go to healthcare and less to the military.
I am not advocating completely free medical nor zero for defense, just a reordering of priorities.

 

You are right. Taxes are high, but I have to tell you, as someone who does not enjoy good health, I get scared thinking about what would happen if I lived there.You are right. I understand that everyone needs to be paid and paid well. But it's big business. Capitalism is great if you are part of the upper crust, so to speak. We on the lower rungs pay the price. So the basics, like health care, should not be left to someone interested in how much they're going to make. There has to be something right about the fact that the poorest of our poor get the same care as the richest of us.

 

Agreed. Australia has a two tier system and I have worked in both. If you want a free TV and foot rub then private is best. If you want top consultants and every possible treatment - public is best. Except in private you have no real "brakes" on expenditure so if grandma who has spent the last 30 years in a nursing home Ga ga - needs ICU treatment for 4 months then that is what she will get because the hospital wins with a nice fat bill to the health insurance company who never asks and cannot ask - "was it worth it"?

The doctors working in the public system know that costs ultimately come out of thier tax dollar and so are more likely to sit the family down and have a talk around quality of life

 

I find it astounding that many in the GOP deny that healthcare should be a right of all citizens.
I feel denying healthcare to people who can't afford it is immoral.
I am an atheist, but the hypocrites, like Pence, who call themselves "christian" are certainly NOT.
I was raised being taught the teachings of Christ, and he did not turn the sick away.

 

Yes. It needs to be about you....all of you. You should have a right to it as an American. There has to be a way. Non-profit and government-run....they're not always the best either, but at least they are accountable in some way....votes

 

Part of the records exist as defensive medicine- doing and recording things which could establish procedures in the event of litigation. Not required by a written regulation of government- by by requirement of your malpractice insurance company, as well as self-defense.

You are certainly right about medical costs bankrupting people- often they can wipe out a lifetime of savings in a week. Those that can't pay do leave costs that get factored in to the bills of others as well. All of which would be well served by not creating unnecessary complexity in the first place and getting control of the huge litigation issues. How long has it been since you watched a few hours TV and didn't see some legal ad promising to get you money if you took some drug or had some medical procedure?

Most doctors hate insurance companies and paperwork, I am well aware of that. Of course the paperwork has a great deal to do with the insurance industry who is operating under substantial regulations as well as legal constraints. Part of the game in all that is to figure out how to do what you need to do within the constraints of regs and laws that are trying to force you to do what they want you too- so there is a lot of creativity. For example there are medical billing firms, whose sole service is to construct bills to get the maximum dollar amount from any particular service. How? For instance, a doctor does an appendectomy, removal of appendix. These service would revise the bill to charge for opening the abdomen as an individual service called a laparectomy, then removing the appendix as another individual service. The game changes as medicare rules change. Breaking things down boosts the bills. Hospitals literally will charge a fee for the handling of patient meds- meaning the nurse handing pills to the patient to take.

It reminds me of the instructions I saw once for a wagon salesman. It said to say "The price of the wagon is $200." If the buyer didn't cringe, you say "And the wheels are $50". If the buyer still didn't cringe, you say "Each". The nurse is paid on an hourly rate, and those hours are factored into room rates on average. But by billing for such things as handing a patient pills, the revenue from the nurse's role climbs, while her paycheck does not. All these thing are being applied to cover expenses that are not directly related to providing health care to the patient. Point is- we have got to get a handle on these excessive expenses, in order to make healthcare a reasonable service.

 

Agreed D. I work in a hospital that is over 800 kilometres from the nearest tertiary centre. If you need a major procedure our there that we cannot do then you are flown via RFDS at government expense with escort - if required nurse medical officer in what is essentially a flying ICU to the coast - all care provided free to you, An escort (a close relative) is flown across as well, at government expense, subsidised accomodation is given to the relative, and you will get free flights back when you are well

And it is STILL cheaper than the American system

One of the costs in the American system is the very itemisation of the bills. We don't - even in private health. It costs so much per day for a bed in a ward and so much for an ICU bed. And I know this means you are effectively subsidising the person that needed more but Americans are doing that now by paying so much for Tylenol (Panadol here)

We started to get a LOT of frivolous lawsuits as well but now we have the health care ombudsman - not perfect and clogged with complaining mental health patients (gotta love personality disorders) but it does reduce the ambulance chasers

 

I think I responded to you, and I'm not a member of the GOP. I don't even like the GOP. Who cares about "christian" and Pence and how you feel? Why can't you come up with a rational response to scrutiny of what you say?

 

Many of the most religious people we meet, do not practice the basic principles of Christianity.

 

And this is where a public system has a bit of an advantage. No profit - to a point. We are tied to the American idea of funding for "Diagnostic Relatied Groups" so again it becomes a paper chase trying to get the most money out of the government for your little corner of the health world - but overall we do not see the profit chase in private that is evident in public

 

Each time we set a precedent, the question of the issue involved changes from yes or no to how much? In other words, we open a door and then we find it very hard to control what comes in as a result. Healthcare is a human service, it is not a natural right, and at best it would be forcing one citizen to pay another's bills. That intrudes on the liberties and constitutional rights of those people, and I think that is immoral too. Do we justify a moral wrong to do a moral right? There is one person on earth put here to care for each of us. Sometimes that person (Your caretaker, who can be found in your mirror) just doesn't do their job- and lets the consequences fall on whomever else is willing to deal with them. I'm not talking about accident or conditions beyond control- I'm talking about the negligence that is part of a lot of chronic health care cases.

I can see many reasons why health care for all would have benefits for the country. However, I have a harder time holding people responsible for the bills that result from the decisions of others. If everyone has free coverage, you pay not only for the person who is in need of help through unfortunate circumstances- you pay for the person who needs help because they refuse to take care of themselves or to participate in the process at all, and there are a lot of them. Personal responsibility is part of this issue. Rewarding and thereby enabling dependency is a precedent that can lead to a world where there is no help for anyone. When everyone leaves the responsibility to someone else and we find we have run out of those willing to fill that role- who will we call on? We see the number of responsible people declining, and the number who think they are entitled to everything growing. Not good. Not fair either.